Provider Demographics
NPI:1194911867
Name:JONES, JUSTIN C (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1849
Mailing Address - Country:US
Mailing Address - Phone:402-733-3932
Mailing Address - Fax:402-733-1933
Practice Address - Street 1:3932 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1849
Practice Address - Country:US
Practice Address - Phone:402-733-3932
Practice Address - Fax:402-733-1933
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071268402Medicaid